AstraZeneca, Gaithersburg, MD.
Evidera, Bethesda, MD.
JCO Oncol Pract. 2020 Oct;16(10):e1232-e1242. doi: 10.1200/JOP.19.00781. Epub 2020 Jun 18.
We conducted a cross-sectional survey of practicing medical oncologists in the United States to obtain insight into physician and patient treatment decision making in stage III non-small-cell lung cancer (NSCLC).
A convenience sample of 150 oncologists completed a 38-question Web-based survey in January 2019.
Surveyed oncologists (82% community based) had an average of 15 years of clinical experience and had treated an average of 20 patients newly diagnosed with stage III NSCLC in the previous 6 months. Oncologists reported presenting 55% of their patients with stage III NSCLC to tumor boards. For patients with new unresectable stage III NSCLC seen in the previous 6 months, concurrent chemoradiation therapy (cCRT) was reported as the initial treatment in an average of 48% of patients. The most frequent reason for delays in starting the initial chosen treatment was insurance preauthorization processes (reported by 65% of oncologists). A total of 55% of all patients with unresectable stage III NSCLC who received cCRT went on to receive consolidation immunotherapy; for patients who received consolidation chemotherapy after cCRT, the rate of immunotherapy was lower (42%). Biomarker test results were given as the reason for oncologists not recommending immunotherapy after cCRT in approximately a quarter of cases. The 112 oncologists with eligible patients who declined immunotherapy reported previous treatment fatigue as the reason in 34% of patients and insurance challenges in 19% of patients.
Oncologists reported notable deviations from treatment guidelines for stage III NSCLC. Our findings highlight important opportunities to improve decision making and the coordination of care in stage III NSCLC.
我们对美国的执业肿瘤学家进行了横断面调查，以深入了解医生和患者在 III 期非小细胞肺癌（NSCLC）中的治疗决策。
2019 年 1 月，150 名肿瘤学家完成了一项 38 个问题的网络调查。
调查的肿瘤学家（82%为社区医生）平均有 15 年的临床经验，在过去 6 个月中平均治疗了 20 名新诊断为 III 期 NSCLC 的患者。肿瘤学家报告称，55%的 III 期 NSCLC 患者被提交给肿瘤委员会。对于过去 6 个月内新诊断为不可切除的 III 期 NSCLC 的患者，报告称 48%的患者接受了同步放化疗（cCRT）作为初始治疗。启动初始选定治疗的最常见延迟原因是保险预授权流程（65%的肿瘤学家报告）。在所有接受 cCRT 的不可切除的 III 期 NSCLC 患者中，有 55%的患者接受了巩固免疫治疗；对于接受 cCRT 后接受巩固化疗的患者，免疫治疗率较低（42%）。大约四分之一的病例中，生物标志物检测结果被肿瘤学家作为不建议在 cCRT 后进行免疫治疗的原因。112 名有资格接受免疫治疗但拒绝免疫治疗的肿瘤学家报告说，在 34%的患者中，之前的治疗疲劳是原因，在 19%的患者中，保险是挑战。
肿瘤学家报告称，III 期 NSCLC 的治疗指南存在明显偏差。我们的研究结果突出了在 III 期 NSCLC 中改善决策和协调护理的重要机会。
